Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 032867 | NY |
NPI | 1003194077 |
---|---|
Provider Name | Mandakini Dhirubhai Desai |
First Address | Jersey City, NJ 07306-5009 |
Second Address | Jersey City, NJ 07306-5009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 25/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
032867 | LICENSE (01) | NY |